Contemporary Reoperative Mitral Valve Surgery: Technical Considerations and Clinical Outcomes

Hassanabad, Ali Fatehi; Turcotte, Michelle; Dennehy, C. G.; Kim, Angela; Malaisrie, S. Chris; Kent, William

doi:10.1177/1556984520949955

Cited by 6 publications

(5 citation statements)

References 113 publications

(166 reference statements)

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“…The mean ICU and hospital stay duration in our series were 68.75±76.06 hours and 10.79±6.79 days, respectively. These findings are constant with other studies in the literature, showed a mean hospital stay ranges from 6.2 to 17.2 days and ICU stay from 18 hours to 13.5 days [7]. In the current era of less-invasive techniques, the right mini-thoracotomy is an attractive alternative to median sternotomy for mitral reoperations to reduce hospital and ICU stay duration and minimize morbidity and mortality.…”

Section: Discussionsupporting

confidence: 85%

“…However, scant data exists in the literature regarding the specific outcome evaluation after redo-mitral valve replacement in this group of patients. In the contemporary literature, reoperative mitral valve surgery remains a surgical challenge due to higher preoperative risk factors that lead to higher rates of in-hospital mortality and postoperative complications [5,7].…”

Section: Discussionmentioning

confidence: 99%

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Redo mitral valve replacement for initially rheumatic heart disease: In-hospital outcomes and operative risk prediction

Amr

Fayad

Kamal

2022

Egypt. Cardiothoracic. Surg.

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Background: Redo mitral valve replacement (redo-MVR) remains a challenge despite advances in surgical techniques. Little is known about the outcomes of redo-MVR in patients with rheumatic heart disease. We aimed To evaluate the in-hospital outcomes and associated risk factors for mortality and morbidity after re-operative mitral valve replacement in patients with initial rheumatic heart disease. Methods: This retrospective cohort study included 214 patients, 96 males (44.9%) and 118 females (55.1%), who underwent redo-MVR between January 2015 and December 2020. The mean age was 41.87±11.7 years. European Heart Surgery Risk Assessment System II (EuroSCORE II), Age, Creatinine, Ejection Fraction (ACEF) scores were used for risk stratification. The primary endpoints were in-hospital mortality, major morbidity (renal failure, prolonged ventilation, stroke, reoperation, or deep sternal wound infection), and the composite outcome of mortality and/or morbidity). Results: Major morbidities occurred in 31.8% of patients, and the in-hospital mortality rate was 19.6%. Predictors of mortality were New York Heart Association class (NYHA) III/IV (OR: 5.4; p˂ 0.001), cardiogenic shock (OR: 13.74, p˂0.001), low left ventricular ejection fraction (LVEF) (OR: 4.36; p= 0.01), and perioperative intra-aortic balloon pump (OR: 6.79; p= 0.01). The significant predictors of mortality and/or major morbidity were NYHA III/IV (OR: 2.39; p˂0.001), low LVEF (OR: 4.44; p= 0.001), active endocarditis (OR: 2.4; p=0.04), and perioperative IABP (OR: 3.88; p= 0.045). EuroSCORE II had better accuracy than the ACEF score to predict adverse outcomes (AUC: 0.70 [95% CI: 0.63-0.78] versus 0.58 [95% CI: 0.50-0.66], p= 0.01) . Conclusion: Advanced NYHA class and low LVEF could be associated with poor outcomes after redo-MVR in patients with primary surgery for rheumatic mitral valve disease. EuroSCORE II is a helpful tool for risk stratification during redo-MVR.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Redo mitral valve replacement for initially rheumatic heart disease: In-hospital outcomes and operative risk prediction

Amr

Fayad

Kamal

2022

Egypt. Cardiothoracic. Surg.

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“…Ann Transl Med 2021 | http://dx.doi.org/10.21037/atm-21-2407 via minimally invasive approaches and resternotomy range from 0% to 13% and from 4.2% to 12%, respectively (17).…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis

Wei¹,

Liu²,

Ma³

et al. 2021

Ann Transl Med

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Background: This study aimed to summarize the perioperative and long-term outcomes of patients with previous mitral valve surgery (MVS) undergoing reoperative mitral valve replacement (MVR). Methods: Data for all reoperative mitral valve replacements (re-MVRs) with or without concomitant tricuspid surgery were analyzed from Guangdong Provincial People's Hospital between January 2013 and December 2019. Propensity score matching resulted in 30 matched pairs with improved balance after matching in baseline covariates. Perioperative data and long-term clinical outcomes were analyzed.Results: Results are based on the matched cohorts between the two groups. The in-hospital mortality was 3.3% (two deaths) in the entire cohort and was not significantly different between the median sternotomy (MS) group and the totally thoracoscopic (TT) group. Most patients in the TT group had their tracheal intubation removed within 24 hours of surgery. The TT group had a diminished requirement for blood transfusion and a reduced 4-day postoperative chest tube drainage amount. The incidence of early major complications, including all-cause death and reoperation due to bleeding, was lower in the TT group. No significant differences were observed in the 7-year survival probability between the two groups. Conclusions:The encouraging results regarding the perioperative and long-term outcomes of patients who underwent a TT re-MVR show that this approach is particularly beneficial for patients requiring reoperation.

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“…Although evidence is currently limited to case series, this relatively low procedural risk intervention has successfully been used to restore haemodynamic stability in post-MI patients with a mechanical complication [49,50]. Other studies have demonstrated the successful application of transcatheter mitral valve repair for the correction of ischemic mitral valve regurgitation in those with advanced chronic mitral valve regurgitation in stable condition and in acute, unstable patients who are not surgical candidates [51]. The use of percutaneous technologies has the potential advantages of rapidly decreasing left ventricular, atrial, and pulmonary artery pressures and increasing cardiac output after mitral valve regurgitation correction.…”

Section: Percutaneous Ventricular Septal Rupture Closure and Edge-to-...mentioning

confidence: 99%

Recent insights into pathophysiology and management of mechanical complications of myocardial infarction

Hassanabad

Elbatarny

Wong

et al. 2021

Current Opinion in Cardiology

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Contemporary Reoperative Mitral Valve Surgery: Technical Considerations and Clinical Outcomes

Cited by 6 publications

References 113 publications

Redo mitral valve replacement for initially rheumatic heart disease: In-hospital outcomes and operative risk prediction

Redo mitral valve replacement for initially rheumatic heart disease: In-hospital outcomes and operative risk prediction

Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis

Recent insights into pathophysiology and management of mechanical complications of myocardial infarction

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